First nights data after years of APAP

[sopherFellow]

   

Newbie data guy, long time APAP user,

Been using a ResMed S8 Autoset for years and had no data to look at.   Just got a S10 Airsense AutoSet and have my first nights data.

What I have concluded based on what I read here:
1.  Can ignore CA events because they are all Wake-to-Sleep or Waking up junk data - so AHI is more properly 3.3 than indicated 4.2
2.  Have clusters of OA even at max pressure of 16.   Seems 16 might not be enough pressure.

For tonight my strategy is:
1.  Move max pressure to 18 and see if OA events decrease
2.  Move EPR from 1 to 2

Looking for some experts to let me know if I'm misinterpreting this

Thanks for any help.

Dennis

[Sleeprider]

Your clusters of OA look like a positional issue that pressure will not resolve. You should see the success many members have had with the soft cervical collar to prevent chin-tucking. The wiki is in my signature links. If you resolve your positional issues, your AHI will drop to very acceptable levels. Also read the Positional Apnea wiki http://www.apneaboard.com/wiki/index.php...onal_Apnea

[Gideon]

Newbie data guy, long time APAP user,

Been using a ResMed S8 Autoset for years and had no data to look at.   Just got a S10 Airsense AutoSet and have my first nights data.

What I have concluded based on what I read here:
1.  Can ignore CA events because they are all Wake-to-Sleep or Waking up junk data - so AHI is more properly 3.3 than indicated 4.2
2.  Have clusters of OA even at max pressure of 16.   Seems 16 might not be enough pressure.

For tonight my strategy is:
1.  Move max pressure to 18 and see if OA events decrease
2.  Move EPR from 1 to 2

Looking for some experts to let me know if I'm misinterpreting this

Thanks for any help.

Dennis

Welcome to the forum.


Your flow rate smooths out right after your Centrals so I too would ignore them.
The clusters of OA do NOT indicate that you need more pressure.  They indicate that most likely your chin is tucking to your chest and causing an obstruction.  Pressure will NOT resolve these, head position will.  If this is consistent then you need to get a soft cervical collar, see my signature for the explanation and details.  I would not ask you to get a collar unless this is persistent.

On your Charts add Flow Limits, shrink Leaks and Cnores to make it fit.  Flow Limits drive increase pressure so they are important.  The fact that you are having RERAs says that you are having significant Flow Limitations.  EPR is a good way to fight these but it is always good to know where you are starting.

16 may not be enough pressure but the indicator is the plateau in the pressure graph, and in this case, the CLUSTER of OA events does not indicate it.  When adding pressure apply the right kind of pressure, I suspect (missing Flow Limit chart) that PS, Pressure Support or EPR is the solution. Not increasing the max pressure.

If you tolerate high pressure there is no issue with raising it all the way to 20.  I run with my max pressure at the machine max because I can do it comfortably.

[sopherFellow]

   

All,
Thanks for your hints.   Attached is a new screenshot with Flow Limit.
It sounds like increasing Max Pressure to 18 may not be necessary but shouldn't be a problem.
Increasing EPR to 2 still seems a good idea.

I have a soft cervical collar which I could put on loosely.  It's not precisely sized per Forum guidelines, but it's here already and I could try it.
It sounds like maybe I should collect data for a few more nights without it before trying it?

This is a great place and you are all very helpful.  I was talking to a fellow CPAP user this morning and remarked that I have learned as much this morning as in all the years that I have been treated.

Thanks again, my quest for knowledge was triggered, of all things, by my Fitbit telling me my sleep was bad - and here we are with real data@@
Dennis

[Melman]

Given your significant flow limitations I suggest you increase EPR to 3 for more pressure support. I wouldn't wait to try the cervical collar. As Sleeprider and Bonjour have pointed out, chin tucking appears to be a major issue..

[Sleeprider]

I agree with Melman. EPR is an effective way to treat flow limitations which drive pressure increases. I have no problem with increasing maximum pressure, especially if you increase EPR to 3, but I'm pretty certain the positional therapy (collar) will be needed unless you can identify an easily solved problem like pillows to stiff or tall that cause the chin-tuck. The new chart is an improvement for helping understand what is going on.

[Gideon]

Based on your chart I too would take the EPR to 3. And no harm in raising the max pressure.

[sopherFellow]

   
Drum roll please.....

2nd nights results - with EPR = 3,  max pressure raised to 18 and wearing a soft cervical collar.

I woke up in the middle of the night, was uncomfortable with the collar and took it off.   That actually makes it even more obvious how much I need it.
The first half, with the collar, is like an apnea nirvana - looking pretty good there.

The second half, after I took the collar off, is not quite so good, although it's better than the night before, when EPR was set to 1.

My conclusions:
Leave EPR at 3
Lower max pressure to 16 - the first time it went up to 18 it blew out my mask and woke me up.   With the collar, seems like I don't need the higher pressure.
Wear the collar ALL night.

Thank you very much - I'm making real progress in optimizing my treatment and it has only been 24 hours.

Dennis

[Sleeprider]

It's not unusual to take a few nights to get accustomed to the collar and for the full benefits to be realized. I agree with your conclusion and this is a significant improvement in therapy, even with only half the night using the collar. I should add some members find the soft cervical collar has a "training" effect and the eventually don't need it, however you should stick with it now. You can see the effect on the flow limitation graph with and without the collar, and that is what drives the pressure.

[Dormeo]

My oh my -- what a dramatic illustration of the value of the cervical collar! If your current collar remains uncomfortable, you might see whether an "anti-snore" collar, like the Dr. Dakota, works better for you. The Dr. D. is stiffer, but it is a half-collar with a strap around the back. If you try it, and if you have trouble fastening it, let us know. There's a little hack I could suggest.

Congratulations on all the improvement!